Neoadjuvant Chemotherapy with Etoposide, Leucovorin, 5-Fluorouracil and Cisplatin for Advanced Esophageal Squamous Cell Carcinoma

Eighteen patients with invasive periadventitial tissue (T4)or distant lymph node metastatic (M1,LYM) squamous cell carcinomawere entered into a pilot study of neoadjuvant chemotherapywith etoposide (50 mg/m²/day, days 1–5), leucovorin (30mg/body/day, days 2–5), 5-fluorouracil (5-FU; 400 mg/m²/day,days 2–5) and cisplatin (100 mg/m²–day, day 1) (ELFP).The overall response rate was 56%. The response rates in theT4 tumor and M1, LYM patients were 56 and 50%, respectively.Radical esophagectomies were performed on six of 17 patientswho had completely recovered from the chemotherapy, a resectabilityof 35%. Histologically, the primary tumor was moderately toslightly effective, and the lymph nodes markedly to moderatelyeffective. Histologic responses in the lymph nodes were differentfrom those in the primary tumors and in each node. There werefour chemo-surgically related deaths. Median survival timesin responding and non-responding patients were nine and threemonths, respectively. In conclusion, neoadjuvant chemotherapywith ELFP appears to be effective against esophageal squamouscell cancer with periadventitial tissue invasion or distantlymph node metastasis. Chemo-surgically related deaths werehowever, 22%, showing neoadjuvant chemotherapy to necessitateextremely careful attention to the medical and surgical managementof patients.